Four North Carolina patients at one hospital tested positive for a type of swine flu that is resistant to Tamiflu, health officials said yesterday. The cases reported at Duke University Medical Center over six weeks make up the biggest cluster seen so far in the U.S. Tamiflu—made by Switzerland’s Roche Group—is one of two flu medicines that help against swine flu. Health officials have been closely watching for signs that the virus is mutating, making the drugs ineffective.

A Richmond man’s death is the latest in Virginia from swine flu, bringing total deaths in the state from the illness to 27. “It indicates that the H1N1 flu is still an issue,“ said Dr. Donald Stern, Richmond City Health District director. “That we have had a death, it does not indicate the virus is changing. It’s still primarily a mild to moderate form of disease. Some individuals, particularly those with underlying health conditions, are at risk. That is why we encourage them to get their vaccine,“ Stern said.

State health officials say they’ve allocated a total of 1.2 million doses of the H1N1 vaccine to Virginia sites in their overall campaign to vaccinate people against the so-called swine flu.

CONCORD, N.H.—Forget cookies and milk. Santa wants the swine-flu vaccine. Many of the nation’s Santas want to be given priority for the vaccine and not just because of those runny-nosed kids. There’s also the not-so-little matter of that round belly. Research has suggested obesity could be a risk factor. Swine flu has become such a concern that the Amalgamated Order of Real Bearded Santas featured a seminar on the illness at a recent conference in Philadelphia. The group also urged its members to use hand sanitizer and take vitamins to boost their immune systems.

Swine flu appears to have been cut in half in Virginia. About 8 percent of people visiting emergency rooms across the state reported flulike illness, down from a high of 15 percent three weeks ago, according to the Virginia Department of Health. “It looks like we’ve gone over a hump,“ said Dr. Marsh Cuttino, an emergency-medicine specialist with HCA Virginia Health System, which operates six Richmond-area hospitals. “We’re back almost to our normal levels.“

Serbia’s health ministry on Wednesday proclaimed a swine flu epidemic, a declaration it hopes will help prevent a surge of the illness in the Balkan country.

5,000: people vaccinated against H1N1 last week by the Virginia Health Department in the Central Region, stretching from Hanover County to the North Carolina line
  36,260: people vaccinated for H1N1 this year by the Health Department in the Central Region
  50,000-80,000: people vaccinated for H1N1 this year by all providers in the Central Region

Swine-flu cases appear to be declining in central Virginia, though the supply of H1N1 vaccine still is lagging behind desired levels. School absenteeism is back to normal levels in the counties of Charles City, Goochland, Hanover and New Kent, a public-health spokesman said yesterday. Absenteeism is declining in Richmond and the counties of Chesterfield and Henrico, while hospital emergency rooms report fewer visits by people with flulike illnesses.

Hundreds of Afghan and international troops already battling a rising militant insurgency are facing a new fight — recovering from swine flu, the virus that has left 11 people dead in the country.

France’s government is launching swine flu vaccinations for targeted high-risk groups, though polls suggest most French people are hesitant about the shots.

Milwaukee police have arrested a man accused of stealing a truck carrying 900 doses of swine flu vaccine.

Flulike illness in the state appeared to decline last week, but deaths caused by the H1N1 flu continue to rise. As of yesterday, 21 deaths across Virginia were being blamed on swine flu. That’s four more than reported earlier this week. “I can’t tell you that we are coming down on the other side of the pandemic curve yet,“ Dr. Karen Remley, Virginia’s health commissioner, said during a news briefing yesterday.

The U.S. Department of Agriculture said Wednesday that pigs in a commercial herd in Indiana have tested positive for swine flu, making it the first time the virus has been found in such hogs.

Hundreds turned out yesterday in Chesterfield County for a flu-vaccine clinic, where 800 doses of H1N1 vaccine were administered.

A leading government health figure says tests on millions of people who have received the H1N1 flu vaccine shows that it’s safe and effective.